congenital rubella and rubella in - epicentro · 2015-09-23 · the congenital rubella and rubella...

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The report is available online at: http://www.epicentro.iss.it/problemi/rosolia/bollettino.asp

Congenital rubella and rubella in pregnancy News

Biannual report N.3 — September 2015

Congenital rubella and rubella in pregnancy surveillance report

The National Measles and Rubella Elimination Plan (PNEMoRc) 2010-2015 includes among its objecti-

ves the reduction of the incidence of congenital rubella to less than one case per 100,000 live births

by 2015, according to the recommendations of the European Region of the World Health Organiza-

tion (WHO-EURO).

In Italy a national surveillance system of congenital rubella and rubella infections in pregnancy is acti-

ve since 2005 in order to monitor progress toward elimination.

This report shows national and regional surveillance data for the period January 2005 - August 2015.

Reclassification of some cases due to updated information may be responsible for minor variation of

data respect to the previous bulletins.

Highlights

In the period January 2005 - August 2015 77 congenital ru-

bella infections (probable and confirmed cases) were re-

ported, with two peaks in 2008 and 2012. Fifty-eight of these

infected newborns had at least one clinical manifestation.

Moreover 163 rubella infections in pregnancy (possible,

probable and confirmed cases) were notified.

In the same period, among the infected women, 32 volun-

tary terminations, 1 stillbirth and 1 spontaneous abortion

were reported.

In the period January 2014 - August 2015, one asymptoma-

tic confirmed congenital rubella case and 1 volontary ter-

mination due to rubella infection were reported. It is, howe-

ver, necessary to keep high the attention, taking into consi-

deration that rubella infection has a ciclic-epidemic trend.

It is necessary to reinforce the follow up of the outcome of

pregnancies and of the status of infection of the newborns

with suspected congenital rubella over time.

Congenital rubella:

national data 2

Rubella in pregnancy:

national data 3

Congenital rubella and

rubella in pregnancy:

regional data 4

The surveillance

system 5

To improve the

surveillance... 6

Useful links… 6

Index

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Congenital rubella: national data

Figure 1. Congenital rubella infections by year and classification. Italy, 2005-2015*

In the period January 2005– August 2015, 77 cases of congenital rubella were reported: 70 confirmed and

7 probable cases according to European Commission case definition.

Furthermore, we received 60 notifications that we could not classify because of lack of information or be-

cause these cases were not monitored over time.

In the first eight months of 2015, no congenital rubella infection was reported.

Figure 1 reports the number of congenital infections (confirmed and probable cases) by year and classifi-

cation. We can observe a peak of notifications in 2008 (30 cases, with an incidence of 5.0 per 100,000 live

births) and one in 2012 (19 cases, with an incidence of 3.6 per 100,000 live births).

Clinical information

Information on clinical manifestations are available for 75 of the 77 probable/confirmed reported cases.

At least one clinical manifestation was reported for 58 cases. The most frequently reported symptoms

were:

Congenital heart disease (41 children)

Loss of hearing (27 children)

Meningoencephalitis (11 children)

Cataract (12 children)

Twenty cases had multiple defects involving the heart, hearing or vision.

Seventeen infants were asymptomatic: they are cases with laboratory confirmation and epidemiological

link.

2 2

30

10

2 2

18

3 1

1

1

1

3

1

0

10

20

30

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015*

Nu

mb

er

of

case

s

Confirmed Probable * preliminary data (Jan--Aug)

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Figure 2. Rubella in pregnancy by year and classification. Italy, 2005-2015*

In the period January 2005– August 2015, 163 cases of rubella in pregnancy (150 confirmed, 9 probable

and 4 possible cases) were reported.

In addition, we received 106 notifications that we were unable to classify with the available information.

In the same period, among the infected women, one stillbirth, one spontaneous abortion and 32 volunta-

ry terminations were reported.

In the first eight months of 2015, one confirmed rubella infection during pregnancy was reported. This Ita-

lian unvaccinated woman experienced a voluntary termination of pregnancy in the 11th week.

The Figure 2 reports the number of rubella infections in pregnancy (confirmed, probable and possible ca-

ses) by year and case classification. We can observe a peak of notifications in 2008 (78 cases) and one in

2012 (50 cases). This temporal trend is consistent with what reported for congenital rubella in the Figure 1.

Rubella in pregnancy: national data

Characteristics of women with rubella infection in pregnancy

(confirmed, probable and possible cases)

The median age is 26 years

14% (23/160) is not italian

42% (46/109) acquired the infection in the first trimester of pregnancy

30% (38/127) performed the rubella antibody screening before pregnancy

46% (70/151) had previous pregnancies

Three women reported to be vaccinated (but the vaccination history was documented only for one

of them)

For 38 women (23%) it is unknown if the infection was transmitted to the newborn, because the out-

come of the pregnancy is unknown or because information regarding the status of infection of the

newborn was not available.

6 1 4

77

7 5 4

40

4 1 1

1

3

0

10

20

30

40

50

60

70

80

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015*

Nu

mb

er

of

case

s

Confirmed Probable Possible

7

1

1

* preliminary data (Jan--Aug)

4




Congenital rubella and rubella in pregnancy: regional data

Tab 1. Congenital rubella cases by Region/A.P., January 2005—August 2015

Table 1 shows the number of cases

(probable and confirmed) of congenital

rubella infection by Region/A.P.

In six regions the annual average inci-

dence was greater than 1 in 100,000 live

births (Figure 3).

Figure 4 shows the number of rubella in-

fection in pregnancy (confirmed, pro-

bable and possible) by Region/A.P.

Figure 3. Annual mean incidence of congenital rubel-

la (confirmed and probable cases) per 100,000 live births by Region/A.P., January 2005—August 2015

Region Cases (N)

Piemonte 6

Lombardia 4

Veneto 2

Emilia-Romagna 3

Toscana 2

Lazio 7

Campania 37

Puglia 2

Calabria 5

Sicilia 5

Sardegna 4

Total 77

Figure 4. Rubella in pregnancy cases (confirmed, probable and possible cases) by

Region/A.P., January 2005—August 2015

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The surveillance system for congenital rubella

and rubella in pregnancy

In Italy the notification of congenital rubella syndrome, congenital rubella infections and rubella infec-

tions in pregnancy is mandatory since the 1st of January 2005.

The national surveillance system for congenital rubella and rubella in pregnancy is mandatory, passive,

case-based and based on clinicians.

Two separate notification forms are used for congenital rubella and rubella infections in pregnancy; the

notification form for congenital rubella also includes a section regarding the mother’s history.

Data flow is described below.

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This report was produced by: Cristina Giambi, Martina Del Manso, Antonino Bella, Antonietta Filia, Maria Cristina Rota,

Gloria Nacca e Silvia Declich and thanks to the precious contribution of the Ministry of Health, Regions and Autonomous

Provinces, Local Health Units and diagnosis laboratories.

Regional representatives for congenital rubella and rubella in pregnancy: Di Giacomo M (Abruzzo); Locuratolo F

(Basilicata); Natter B (PA Bolzano); Mignuoli A (Calabria); Pizzuti R, De Gaetano A (Campania); Pascucci MG, Moschel-

la L, Frasca G (Emilia-Romagna); Gallo T, Braida C (Friuli Venezia Giulia); Vitagliano A, Guerra M, Scognamiglio P

(Lazio); Cremonesi I (Liguria); Coppola L, Piatti A (Lombardia); Fiacchini D, Damiani N (Marche); Ponzio GV, Bagnoli

C (Molise); Ferrara L (Piemonte); Prato R, Cappelli MG (Puglia); Salotto M, Cadau P (Sardegna); Palermo M (Sicilia);

Balocchini E, Gallicchio S, Pecori L (Toscana); Carraro V (PA Trento); Ruffier M (Valle d’Aosta); Russo F, Zanella R

(Veneto); Tosti A (Umbria).

We thank Wilma Buffolano, coordinator of the Registry of Perinatal Infections and the Network of the Delivery Clinics (RePuNaRC) for

Campania Region, for the precious contribution to the surveillance and follow up of cases.

The congenital rubella and rubella in pregnancy surveillance is made with the financial support of the Ministry of Health - CCM.

To be cited as follow: Giambi C, Del Manso M, Bella A, Filia A, Rota MC, Nacca G, e Declich S. Rosolia congenita e in gravidanza News, September 2015.

To improve the surveillance...

Improving the sensitivity and specificity of the surveillance system is important to monitor the epidemiology of the infection and

progresses towards elimination and to plan actions to reduce the amount of susceptible women in childbearing age.

Strengthening the surveillance of pregnant women with suspected rubella infection is fundamental because it is an entry point for

congenital rubella cases. Early diagnosis of congenital rubella cases also allows quick interventions for any associated defect and

prevention of rubella spread from infected infants.

Monitoring of infected pregnant women is also important to record all the outcomes of the pregnancy, including stillbirth, sponta-

neous and voluntary terminations, that contribute to assess the burden of congenital rubella.

It is important that all the babies born from mothers with possible, probable and confirmed infection in pregnancy are followed up

over time with laboratory, clinical and diagnostic investigations, in order to confirm or exclude the congenital infection and cor-

rectly classify the cases as infection or syndrome. In fact, a long follow up is necessary to definitively classify cases, being laborato-

ry confirmation of congenital infection not always possible at birth (for instance, in case of infants that are IgM negative at birth,

the decline of rubella-specific IgG levels by 6-12 months allows to exclude the infection) and also because clinical manifestations

can be recognized in later infancy.

It is necessary to improve the timeliness of the collection of clinical information and laboratory results and their completeness, in

order to reduce the amount of cases that cannot be classified.

A monthly report of congenital infections and infections in pregnancy, including zero-reporting, is needed to improve the sensitivi-

ty and the timeliness of the surveillance system.

2012 European Commission case definitions for rubella and congenital rubella: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:262:0001:0057:EN:PDF

Italian Ministry of Health. National Plan for the elimination of measles and congenital rubella 2010-2015. http://www.salute.gov.it/imgs/

C_17_pubblicazioni_1519_allegato.pdf (in Italian)

Italian Ministry of Health. “Surveillance of congenital rubella and rubella infection in pregnancy according to the new National Plan for measles and congenital rubella elimination 2010-2015” del 17 Luglio 2013: http://www.trovanorme.salute.gov.it/norme/

renderNormsanPdf?anno=0&codLeg=46583&parte=1%20&serie= (in Italian)

Morbillo & Rosolia News: the monthly bullettin of the integrated measles and rubella surveillance: http://www.epicentro.iss.it/problemi/

morbillo/bollettino.asp (in Italian)

Scientific publication: “Congenital rubella still a public health problem in Italy: analysis of national surveillance data from 2005 to

2013” Euro Surveill. 2015;20(16):pii=21103: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21103

Scientific publication: “Surveillance of congenital rubella and rubella infections in pregnancy in EU/EEA countries, 2012: Current

status and future perspective to monitor elimination.” Vaccine 2015; 33(38): 4929–4937

Useful links...

http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:262:0001:0057:EN:PDF

http://www.salute.gov.it/imgs/C_17_pubblicazioni_1519_allegato.pdf

http://www.salute.gov.it/imgs/C_17_pubblicazioni_1519_allegato.pdf

http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=0&codLeg=46583&parte=1%20&serie

http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=0&codLeg=46583&parte=1%20&serie

http://www.epicentro.iss.it/problemi/morbillo/bollettino.asp

http://www.epicentro.iss.it/problemi/morbillo/bollettino.asp

congenital rubella and rubella in - epicentro · 2015-09-23 · the congenital rubella and rubella...

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